Medical Tests & Procedures Archive

Articles

Ask the doctor: What happens to the plastic beads injected during uterine artery embolization?

Q. Ten years ago, I had uterine artery embolization to get rid of uterine fibroids. How long do the plastic particles they inject into the arteries stay in the body? Do they dissolve?

A. Uterine artery embolization (UAE), also called uterine fibroid embolization, is a minimally invasive treatment that shrinks uterine fibroids by cutting off their blood supply. During UAE, an interventional radiologist inserts a catheter into the femoral artery through a small nick in the skin at the groin and guides it into one of the two uterine arteries, which supply blood to the uterus. Contrast dye is injected to help visualize the uterine artery as well as the smaller branching vessels that feed the fibroid. The radiologist then injects tiny synthetic particles, or beads, which concentrate in the smaller vessels, forming a clot that cuts off the fibroid's blood supply. Lacking blood, the fibroid gradually shrinks.

Angioplasty a day after a heart attack not worth it

Medical therapy is better for late treatment.

Imagine this scenario: You've finally gone to the hospital because of chest pain you were having yesterday. After an electrocardiogram and blood test, you're told that sometime in the preceding 24 hours a clot in one of your coronary arteries cut off the blood supply to a section of your heart muscle. You had a heart attack!

So should you get an artery-opening angioplasty?

No. In 2006, the Occluded Artery Trial (OAT) determined that performing angioplasty — an invasive and expensive procedure — delivered no tangible benefit to people who'd had a heart attack more than 24 hours earlier and who no longer had symptoms.

Heart Beat: Just-in-case electrocardiograms not recommended

Checking your heart's electrical activity with an electrocardiogram (ECG) or exercise stress test makes perfect sense if you or your doctor suspects cardiac trouble. What if you feel fine — no chest pain, shortness of breath or tiredness, or other symptoms of heart disease? Should you have an ECG or exercise stress test to "check under the hood" for undiscovered heart disease? No, says the U.S. Preventive Services Task Force, an independent panel of experts whose recommendations help define high-quality preventive health care for Americans (Annals of Internal Medicine, Sept. 20, 2011). The recommendation reaffirms the group's 2004 advice.

The task force found no evidence that a screening ECG or stress test — screening means checking apparently healthy people to see if they have an undiagnosed condition — will change your cardiovascular risk classification or the way you manage your heart health. And while an ECG is one of the safest tests around, it can lead to additional tests such as an angiogram or a cardiac CT scan. Those methods come with their own risks, such as the chance of bleeding or stroke with an angiogram, and radiation exposure with cardiac CT.

Heart attack treatment happening faster

Good news for heart attack victims: hospitals across the country have shaved more than 30 minutes off the time it takes to begin artery-opening angioplasty and stent placement, the best treatment for a heart attack in progress.

Hospitals use a measure called door-to-balloon time (named after the balloon used to open an artery) to track how quickly they can get a patient from his or her arrival at the hospital to the start of angioplasty. In 2005, the median door-to-balloon time was 96 minutes. At the end of 2010, it was 64 minutes (Circulation, Aug. 30, 2011). That's a remarkable improvement, prompted by efforts from the American Heart Association, the American College of Cardiology, and other organizations.

Atrial ablation on video

Atrial ablation, also called percutaneous pulmonary vein isolation for atrial fibrillation, is a medical procedure that uses small bursts of electricity to stop patches of heart tissue from sending out "beat now" signals that cause the upper chambers of the heart to beat fast and wildly. As part of its Diagnostic and Therapeutic Cardiovascular Procedures section, the journal Circulation has posted a video of the procedure. This particular atrial ablation was done by Drs. Gregory F. Michaud and Roy John, of Harvard-affiliated Brigham and Women's Hospital.

October 2011 references and further reading

Blood vessel disease linked to dementia

Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, Petersen RC, Schneider JA, Tzourio C, Arnett DK, Bennett DA, Chui HC, Higashida RT, Lindquist R, Nilsson PM, Roman GC, Sellke FW, Seshadri S. Vascular contributions to cognitive impairment and dementia. Stroke 2011.

Angioplasty via wrist artery safe, effective

Jolly SS, Yusuf S, Cairns J, Niemela K, Xavier D, Widimsky P, Budaj A, Niemela M, Valentin V, Lewis BS, Avezum A, Steg PG, Rao SV, Gao P, Afzal R, Joyner CD, Chrolavicius S, Mehta SR. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 2011; 377:1409-20.

Update on vibration therapy for bone health

Can gentle vibration improve bone density and prevent fractures after menopause?

Soon you may be hearing a lot about low-intensity vibration therapy for strengthening bones and reducing the risk of fractures. Two low-intensity oscillating devices designed for home use are coming onto the market, and the Agency for Healthcare Research and Quality (AHRQ), which advises the federal government on health care matters, is expected to issue a report highlighting the evidence as well as the many unanswered questions about this unique approach to bone health.

How to get rid of warts

Warts are an unsightly nuisance that can take a year or more to go away on their own. Several effective, noninvasive treatments are available.

Ask the doctor: Is abdominal surgery riskier if I am overweight?

Q. I am overweight and need abdominal surgery. Does being overweight make the surgery more difficult and add to the complication rate?

A. We all have a fair amount of fatty tissue in our abdominal cavities that surgeons must deal with during abdominal operations. The more fat you have, the more difficult the operation is for the surgeon. Excessive fatty tissue impairs access to the surgical site. It can also make the surgery itself — the cutting of tissue — more complex. Operations on obese patients tend to take longer for these and other reasons.

COURAGE not followed by action

Results of landmark trial have little effect on use of angioplasty.

The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial should have been a game changer for people with stable angina (chest pain from cholesterol-clogged coronary arteries) or a severe narrowing in one or more coronary arteries. In such individuals, COURAGE showed that artery-widening angioplasty plus stent implantation was no better than optimal medical therapy at preventing heart attacks or improving survival. In other words, it made sense to first try medical therapy — that is, drug treatment and lifestyle changes — and turn to angioplasty if it didn't work.

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